Provider Demographics
NPI:1407300312
Name:GROSS, LINDA (MS, RD,LDN)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:
Last Name:GROSS
Suffix:
Gender:F
Credentials:MS, RD,LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4917 GOLFVIEW CT
Mailing Address - Street 2:
Mailing Address - City:MINT HILL
Mailing Address - State:NC
Mailing Address - Zip Code:28227-9238
Mailing Address - Country:US
Mailing Address - Phone:704-451-1597
Mailing Address - Fax:
Practice Address - Street 1:4917 GOLFVIEW CT
Practice Address - Street 2:
Practice Address - City:MINT HILL
Practice Address - State:NC
Practice Address - Zip Code:28227-9238
Practice Address - Country:US
Practice Address - Phone:704-451-1597
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-09
Last Update Date:2016-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL001092133VN1005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1005XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Renal
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCL001092OtherSTATE LICENSURE